BACKGROUND: Elevated right atrial pressure (RAP) is generally considered a sign of right ventricular failure(RVF) and poor prognosis in patients with pulmonary arterial hypertension (PAH). In most studies of PAH , elevated RAP does not respond to therapy with diuretics and pulmonary vasodilators (Gomberg-Maitland M et al JACC 2011:57:1053-61), We evaluated four patients referred for evaluation of pulmonary hypertension (PH) with COPD and volume overload and elevated RAP with serial right heart ctaheterization (RHC) before and after therapy with diuretics alone.

RESULTS: After diuretic therapy RAP and PVR decreased dramatically (figs). MPAP and PAWP decreased significantly as well.. Two of the patients were being considered for parenteral prostanoid therapy, but all pts were able to be managed with oral therapy alone, with two pts. on diuretic therapy alone. One pt had a large pericardial effusion, which resolved completely after diuretics.

CONCLUSION: Elevated RAP in some pts with COPD and PH may be related to hyperinflation and increased intrthoracic (extracardiac) pressure and not to RVF. Diuretic therapy alone may effect major chnages in the hemodynamic profile of these pts and should be given before decisions regarding medical therapy of PH are made.